The Monday Memo

May 21, 2018 PITT DPT STUDENTS

PTs as Leaders

Leadership dons many colors. There is no singular quality that defines it, and no distinct formula that produces the individuals who exhibit it. The act of leading is a multifaceted endeavor imbued with nuance and shaped by instinct. As budding leaders in the field of physical therapy, these are ideas that should not be readily forgotten – especially in the ever-evolving landscape of healthcare – and as such, particular attention should be given to the foundational traits that allow us to have the greatest impact among our colleagues and those we rehabilitate. As we look to “transform society by optimizing movement to improve the human experience”, it is essential that we commit ourselves to visionary thinking and refining the skills required to communicate those thoughts.

Leadership is many times firmly associated with the qualities most representative of delegation. While unfortunate, this is not without merit as leading requires the ability to coordinate many individuals and unify an effort in the direction of one common goal. In physical therapy we see this most commonly in the collaboration between therapists, assistants, rehab aides, and administrative staff. However, to see leadership solely in this capacity is both an incomplete and one-dimensional assessment. The act of delegation is simply a conduit for the communication of a greater vision, and without vision the operation ceases to exist. Whether it be for a single patient or an entire cohort, a leader in physical therapy cannot affect change in absence of innovative thought. Patient care is a dynamic process because the patients are inherently dynamic themselves. They are fluid in both their internal and external environment, and the only way we can accommodate this is if we are fluid as well. We cannot afford to be static and we most certainly cannot expect to apply cookie-cutter methodology to every patient of the same ailment. We must be malleable and adaptable so that we can best execute the overarching goals of our care and meet the needs of the individual.

Equally important to the formation of this vision is how we choose to communicate it. Patient care is a complex network of various healthcare professionals and the community in which the patient exists. The success of our care is ultimately dependent upon how we articulate our course of action and the interventions we utilize. How we construct that communication comes first from the insight we glean from the patient profile. From here we can begin to devise how we conduct our patient interview and collect the information necessary for formulation of a plan of care. Further synthesizing that information is entirely dependent upon our ability to listen to not only the patient’s story, but also its subtext. To put it simply, our insight only goes as far as our willingness to listen, and its quality only as strong as our empathy. We may guide the patient through their rehabilitation, but they ultimately guide our treatment decisions. Through this marriage of insight, active listening, and empathy we can develop the clearest picture of our patients and a much more linear, streamlined approach to communicating their care.

Though a leader in physical therapy is not limited these skills in practice, they are essential foundational pieces on which to build our influence. By situating these elements within our scope of care, we will not only initiate a transformation, we will also pioneer progress.

The Monday Memo

May 14, 2018 PITT DPT STUDENTS

Two Runner Specific Pelvic Stability Drills

Most serious runners know the importance of strong glutes, but may not understand how they complement & interact w/ the hip flexors! It’s accurate to describe these muscle groups as being antagonistic, because they perform opposite functions, but this is too simplistic in my opinion.

In reality, these muscle groups complement one another in functional movement! We can think of one group stabilizing & locking down the pelvis, allowing a strong, stable platform for the other to produce force!

Let’s dive into this concept w/ two stability drills that focus on this concept of “pelvic stability” from opposing ends.

Here the hip flexors work to maintain pelvic position as we extend the other hip using our glutes. If the glutes were left unchecked, they would pull the pelvis into a posterior tilt & limit the amount of force we can apply to the ground in gait. Instead, the band activates our hip flexors, allowing them to produce a strong isometric contraction that maintains stability.

Applying this to running, this drill can provide carryover to backside running mechanics, or our ability to exert force to the ground & propel forward. We’re training our hip extensors to contract in a dynamic (concentric/eccentric) fashion with this drill.

What to look out for:

In the case of weak & dysfunctional hip flexors, we may see compensation patterns from the other stabilizing muscles, such as the muscles in our lower back, in which we could see arching of the lumbar spine. The trainee will likely feel the movement less in their anterior core and more so in their lumbar erectors if this is the case.

In addition, the trainee may drive into excessive lumbar flexion. The trainee may still feel the exercise in their hip flexors and anterior core, but they’ll likely lack the sensation of stiffness and power in the hip extensors of the extending leg.

Glutebridge Psoas March

What’s happening:

Here we see just the opposite! The sustained glutebridge provides a constant isometric contraction that stabilizes our pelvis as we drive our knee to our chest using our hip flexors. In contrast to the Supine Psoas March, we’re now training our hip flexors to contract dynamically! They produce a strong concentric contraction as you drive knee-to-chest and contract eccentrically to fight the band with the return to the starting position in a controlled manner.

Applying this to the gait cycle, this is truly a frontside mechanics drill. The importance of driving your knee forward is often overlooked, but it will be difficult generating any sort of speed on hills or during a true sprint w/out effective strong hip flexors.

What to look out for:

Without functional glutes, the hip flexor contraction may spill our pelvis forward into an anterior pelvic tilt. In addition, the trainee will likely have difficulty simply maintaining the starting position. In this case, it would likely benefit the individual to choose another drill, such as a Glutebridge March and/or Single-Leg Glutebridge variations, paired with hip flexor strengthening that don’t demand the same type of performance from the glutes.

The Monday Memo

Q: Hey Guys. To get started, would you mind telling us a little bit about yourself: Where did you grow up? Where and what did you study for your undergraduate education?

Bobbie: I bleed black and gold! Pittsburgh born and raised! I went to Allegheny College for my undergraduate where I majored in Neuroscience and minored in English.

Emily: I grew up in New Jersey 20 mins from NYC and came to Pitt for my undergraduate, which is a BS in Rehabilitation Science. Even though I’ve lived in Pittsburgh for a while I don’t bleed black and gold yet like Bobbie.

Q: You guys were/ are both involved on a rugby team. Tell us a little about that. How’d you get involved?

B: I was committed to playing softball at Allegheny, but it was as a walk on status (long story, but I had a spot on the team). However, my final year playing in high school was challenging and I kinda lost my passion for it. I signed up for rugby at the activity fair….not to be a total dork, but I was looking for the Quidditch booth ( “Q” and “R” are super close in the alphabet…). I signed up at the rugby booth with no real commitment (plus Allegheny did not have a Quidditch team at the time….I believe they do now).

….I went to one practice and literally fell in love….I will start my 8th season this year.

E: I remember wanting to play for the LONGEST time- since I first found out rugby was a sport in middle school, but I always just stuck to being a goalkeeper in soccer. My first real exposure to the sport was when I visited my sister at college and watched her team play- I was definitely hooked. Unfortunately, I tore my ACL just before college started, but fortunately I’m too stubborn to let that stop me. I still joined the club rugby team at Pitt and acted as the cheering crew for the first semester. Then when I was fully recovered, I played with them for the duration of undergrad. I always try to seek out local teams though- I played when I was studying in Ireland, while living in Anchorage, and for the first year of PT school with Bobbie on a local Pittsburgh team. I just made the tough decision this past fall to retire, but who knows if that will be permanent.

Q: What position do you play and could you describe it for those of us who aren’t as familiar rugby?

B: Rugby is unique in the fact that the number on the back on your jersey determines your spot. There are 15 people on the field per team. Numbers 1-8 are forwards, who are simply thought to do the “heavy lifting.” Numbers 10-15 are the backs, who are simply thought to be the “fast or quick players.” I know I forgot number 9….who is the scrum half. This is the link between the forwards and backs and is thought to be “the quarterback of rugby.” While I have played all the positions, I mainly play in the forwards. Currently, I play number 2 A.K.A the hooker (I realize how that sounds…) But the position is called that because in the scrums, it is my job to “hook” the ball back to my team to gain possession.

E: I’ve also played multiple positions but I’m always a forward because I run about as fast as a snail. Most of the time I’m a prop because in the scrum I support the hooker (let the jokes continue) and “prop” up the scrum to keep it from collapsing. A scrum is one of the most recognizable things about rugby- it’s when 8 players from each team form a sort of battering ram and push against each other for control of the ball after a penalty. The other notable thing people think of with rugby is our lineouts which happens when the ball goes out of bounds. It’s similar to a throw-in in soccer, but with rugby you have players jumping and being lifted high into the air by their teammates to fight for possession of the ball. My jumping is as pitiful as my running so I do the lifting.

Q: Rugby is known for being a tough sport, tackling with fewer pads involved. Any comment on this?

B: I think all sports have their dangers and rugby is no different. However, if you practice and use the right technique, the dangers drastically decrease. Rugby tackling is very different from football tackling and honestly, over half the tackles I watch in football would result in a penalty in rugby. There are no pads, so I think generally people realize they have to be smart about play to avoid injury. That being said, I have had some nasty bruises in my days. The only equipment you need is a mouth guard and boots (soccer cleats). But you can opt to wear a scrum hat, which I do.

E: I agree that Americans get really deterred when they hear no pads because they immediately think of football tackles which are pretty different from rugby tackles. New players aren’t even allowed to practice in full contact until they learn how to tackle and fall with proper techniques that emphasize safety over power. Obviously when you slam your body into another person you’re going to have some bruises no matter how perfect your form is, but the only injury I even sustained while playing happened because I had sloppy form. There’s a lot of hard work behind the scenes that is focused on playing safe. Many of the official rules are specifically in place to prevent dangerous play and it’s the referee’s primary job to make sure those are followed.

Q: As future physical therapists, how do you think your involvement in the sport will contribute to your future practice?

B: I think it is important to have passions outside of PT. I love rugby and I wish I had found it out sooner to be honest. Rugby, like PT, allows me to continue to challenge myself physically and mentally. I have had the pleasure to treat a couple patients who play rugby and I enjoy thinking up TE that they can use during rugby. It also has cross over to other sports like soccer and football, so I can emphasize with those patient populations and create programs that are functionally fun.

E: The culture surrounding rugby has often been described as cult-like, but you’d be hard pressed to find people more open and accepting. The sport inherently requires a team of players who are diverse in their abilities; the muscly and strong forwards are just as important as the speedy and agile backs. Though the banter between the two sides would lead you to question if we even play the same sport, we welcome these differences and challenge each other to improve and achieve our goals as players. I think this translates really well to my future as a PT where no two patients will be alike and it’s my job to assess their strengths, abilities, weaknesses, and limitations no matter how different they may be and then help them improve to achieve their own goals.

Q: Any competitions in the near future?

B: Our team plays year-round basically. We have games this spring and USA rugby has not yet released our main competitive fall season. When the dates are in, we can post them around if people are interested.

E: Yeah come out for a game or two! It’s a ton of fun to watch and the players are always chatty and willing to answer questions about the game.

Q: What are your career goals or next steps after your graduate?

B: Is undecided still an option here?? I did one inpatient stay my first year and liked it more than I expected….But I also have been working for UPMC for 6 years as a rehab aide in an outpatient setting and I love that….Can I just say I love PT here?

E: I’ve gravitated towards outpatient ortho with past rotations but I don’t have a particular preference for PT settings. I reeeeeally dig the idea of travel PT though. Getting paid to travel around the country and do a job that I love? Yes please!

Q: Anything else you’d like to share with the readers?

B: Don’t let Rugby intimidate you!! Its super fun and if anyone ever wants to come to a practice to just try it….you are always welcomed!! J Don’t knock it till you try it!

E: Not just rugby- don’t knock any sport until you try it. People who have been playing for years make it look easy and it can be disheartening when you’re not immediately a great player. That being said, rugby has an awesome group of people who are more than happy to put in the time and effort to make sure you’re safe and having fun while playing.

The Monday Memo

April 30, 2018 PITT DPT STUDENTS

Maysoon Zayid’s “I got 99 problems… palsy is just one.”

To the Class of 2020, congratulations on completing another semester of PT school. Rest up, because we’ve earned it. After two wonderful weeks of break, we will be embarking on the educational journey that is pediatrics, so I wanted to introduce a famous disability advocate who is diagnosed with one of the most common pediatric movement disorders.

“My name is Maysoon Zayid and I am not drunk, but the doctor who delivered me was. He cut my mom six different times in six different directions. As a result, I have Cerebral Palsy which means I shake all the time… It’s exhausting. I’m like Shakira Shakira meets Muhammad Ali.”

Maysoon Zayid is an Arab-American comedian diagnosed with Cerebral Palsy. Her parents couldn’t afford physical therapy, so they sent her to dance school. She went to Arizona State University for acting and after graduation, earned a role in Adam Sandler’s movie Don’t Mess with the Zohan. She tap-danced on Broadway and is the co-founder of the New York Arab-American Comedy Festival. She also founded Maysoon’s Kids which supports disabled and orphaned Palestinian refugee children. Most importantly, she has a cat named Beyoncé so that she can say she lives with Beyoncé. You can view a 15-minute clip of her Ted Talk that has had over 48 million views here (which I highly recommend because it’s hilarious): https://www.youtube.com/watch?v=buRLc2eWGPQ&t=22s

“My father taught me how to walk when I was five years old by placing my heels on his feet and just walking. Another tactic that he would use is he would dangle a dollar bill in front of me and have me chase it”

Cerebral Palsy is a non-progressive motor dysfunction caused by abnormal brain development. The hallmark of is a limited ability to voluntarily move and maintain balance as a result of a central nervous system lesion, specifically a lack of oxygen to the brain at some point in early development. Not all children “shake” like Maysoon described. Her symptoms of dyskinesia are characteristic of damage to the basal ganglia while ataxia is associated with damage to the cerebellum. Between 70-80% of individuals with cerebral palsy experience spasticity, which is associated with damage to or developmental differences in the cerebral cortex.

Cerebral Palsy is considered when a child does not reach developmental milestones and achieve growth chart standards for their height and weight. Symptoms can vary with mild symptoms, only having difficulty with fine motor skills in grasping and manipulating items with their hands. Severe symptoms include significant muscle problems in all four limbs, epilepsy, and difficulties with vision, speech, or audition. Cerebral palsy may have a neurological diagnosis but affects the musculoskeletal and cardiopulmonary systems.

“But one miracle cure we did find was yoga. I have to tell you, it’s very boring. But before yoga, I was a stand-up comedian who can’t stand up. And now, I can stand on my head! My parents reinforced this notion that I could do anything. That no dream was impossible, and my dream was to be on the daytime soap opera General Hospital!”

Pediatric physical therapy has a critical role in improving functional activities that are both fun and meaningful to the patient. As with any kid, if they don’t want to do something, they will let you know. One kiddo I’ve worked with didn’t like wearing his AFO’s so he buried them in his backyard and didn’t tell his mom. The primary goals of physical therapy are to improve balance and coordination, build strength, increase flexibility, and maximize independence. Occupational therapy and speech therapy may also be a part of the interdisciplinary team. Research shows that Hippotherapy and Aquatic Therapy are very beneficial as well (https://www.youtube.com/watch?v=T3VnFT7HiJU). Patients that I have helped with as an aid at Children’s hospital came to physical therapy, so they can play baseball, soccer, basketball, lacrosse, sled hockey, and walk by themselves at their high school graduation.

“I’ve got 99 problems and palsy is just one. If there was an Oppression Olympics, I would win the gold medal. I’m Palestinian, Muslim, I’m female, I’m disabled, and… I live in New Jersey.”

Maysoon uses comedy to fight for equality. Disabled people represent 20% of the population, incorporating every other diversity group. Only 2% of the images you see are disabled and 95% of that 2% are played by non-disabled actors. Her goal is to create a more positive image of disability in the media. If you’re interested in learning more, check out her website! It has her blog, up-to-date news, and some of her stand-up sketches: https://maysoon.com

The Monday Memo

April 23, 2018 PITT DPT STUDENTS

Finals Approaching!

It’s that time in the semester again when sleep gets sacrificed, stress skyrockets, and most students’ overall sanity is challenged. Yes, I am referring to final exams. While finals are important, your physical and mental health, are just as, if not more, important. During this time of heightened stress on your body it is important to follow a few tips to reduce the chance of overloading your system and maximize your chance at success. Below are a few things to try:

SLEEP! – I know this may sound counterintuitive, but making sure you get enough sleep during finals week will ensure that you are able to work and study efficiently. Additionally, it will help with memory consolidation (remembering the information)!

Exercise! – Being active during finals week is essential for optimizing blood flow to your brain during times of extended sitting and studying. I know there is not a lot of free time to workout during finals week, but even a short 15-30 minute bout of exercise can make all the difference. This could include a walk, jog, or gym session, among other things.

Minimize Social Media! – This may be a tough one for most people, but reducing distractions is important for maximizing efficiency. Even if you are not able to completely log off for the week, try to set goals or time blocks before you are allowed to be distracted by your phone or social media accounts.

Keep Eating! – It may be difficult to keep eating consistent nutritious meals all week because of crazy schedules and reduced free time, but it is important for increasing your energy during those long hours. Try to stick to balanced meals and avoid stress overeating to avoid a crash. It may be beneficial to do a small meal prep for the week to have some meals and snacks ready to eat when you are too drained to cook. Also, do not be afraid to treat yourself throughout the week for all of your hard work!

Relax! – Now, this is not to say lounge around all day hoping the information will learn itself. However, it is important to give your brain a break, reduce the stress, and take a second to experience something outside of studying and homework. You could choose your favorite form of meditation (yoga), listening to music, going to dinner with friends, watching a sports game (Go Pens!) etc.

Hopefully these tips help you a little, but at the end of the day every student studies and prepares a little differently so stick with what makes you feel most comfortable. Make sure to support your classmates, and have confidence in yourself. Good Luck!